Post-hospital Care Research Articles

PRACTICES OF HOSPITAL NURSES FOR CONTINUITY OF CARE IN PRIMARY CARE: AN EXPLORATORY STUDY

ABSTRACT Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.

Community pharmacy will transform post-hospital care in 2021

Community pharmacy will transform post-hospital care in 2021

Tackling AKI: prevention, timing of dialysis and follow-up.

Timely diagnosis and dialytic treatment of acute kidney injury (AKI) came to the forefront at the height of the coronavirus disease 2019 pandemic as admissions surged in intensive care units. Research on early diagnosis, timing of initiation of kidney replacement therapy, and appropriate post-hospitalization patient care remains essential to tackling the burden of AKI.

Care Team Members’ Perceptions of an Informatics Intervention to Improve Geriatric Care Across Multiple sites

Electronic health information exchange (HIE) may improve care for geriatric patients receiving care across multiple sites by reducing test duplication, medication prescribing errors, and adverse events. This project evaluated the implementation of an HIE intervention at two VA medical centers offering VA providers real-time notification of non-VA inpatient or ED use, followed by post-hospital geriatric care coordination. We interviewed 23 providers (physicians, nurses, social workers and other care team staff) about their experiences with the program. Interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) to examine 1) goals and expectations for notifications and transitional care; 2) barriers to effective use of notifications and coordination; and 3) suggestions for improvement. Overall, care team members were positive about the intervention, noting it cut down on time searching for outside medical records and that care coordination visits were helpful in answering patients’ questions and clarifying discharge instructions. However, some providers were not aware of the alerts, found the HIE interface challenging to use, or were concerned that expanding the program would create workflow issues. Suggestions for improvements included sharing information about newly prescribed medications, lab and radiological tests, and progress alerts during the episode of care; and including non-VA providers to facilitate care coordination. Social workers also asked to be included on alerts to improve follow-up. Our findings suggest HIE can be a useful tool for coordinating care across sites, provided information can be easily shared between all care team members and HIE interfaces are streamlined to reduce additional work.

Post-Hospital Care Intensity Modifies the Relationship Between Depressive Symptoms and Hospital Readmissions

The objective of this study was to examine whether more structured post-acute care reduces the deleterious impact of depressive symptoms on older adults’ post-hospital outcomes (30-day hospital readmissions, 30-day falls, 1-year falls, and 1-year mortality). The sample comprised 23,485 eligible index hospitalizations from 7,151 unique fee-for-service Medicare beneficiaries from Health and Retirement Study linked to Medicare claims from 2000 to 2014. Depressive symptoms were measured using the eight-item Center for Epidemiologic Scale - Depression. We ran multinomial probit models regressing post-hospital setting on depressive symptoms while adjusting for sociodemographic factors, socioeconomic factors, family support, and health status. Then, we ran adjusted logistic regression models of each outcome while interacting depressive symptoms with post-acute care setting. We found that 62% of hospitalizations were routine discharges home, 17% were discharged to home health, and 21% were discharged to a Skilled Nursing Facilities (SNF). When adjusting for sociodemographic and socioeconomic factors, each increasing depressive symptom was associated with a half percentage point higher probability of referral to home health and 1.6 percentage points higher probability of discharge to SNFs, driven by differences in family support and health status. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day readmissions (OR=0.95, p=0.027). However, post-acute care settings did not modify the association of depressive symptoms with falls or mortality. Considering depressive symptoms in discharge decisions, above and beyond their associations with family support or health status, may help hospitals avoid readmissions but may not improve health and functioning.

Trends in inpatient discharges with drug or alcohol admission diagnoses to a skilled nursing facility among older adults, New York City 2008\u20132014

BackgroundRecent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. However, no study examines trends in discharges to a skilled nursing facility (SNF) after a drug or alcohol-related hospitalization. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Therefore, the objective of this study was to estimate trends in drug or alcohol-related hospitalizations with discharge to a SNF among adults age 55 and older.MethodsWe analyzed data from New York State’s Statewide Planning and Research Cooperative System to calculate the number of cannabis, cocaine, opioid, and alcohol-related hospitalizations in New York City that resulted in discharge to a SNF from 2008 to 2014 among adults age 55 and older. Using New York City population estimates modified from US Census Bureau, we calculated age-specific rates per 100,000 adults. Trend tests were estimated using joinpoint regressions to calculate annual percentage change (APC) with 95% confidence intervals (CI) and stratified by adults age 55–64 and adults age 65 and older.ResultsDuring the study period, among adults age 55–64, there were significant increases in cocaine, cannabis, and opioid-related hospitalizations that resulted in discharge to a SNF. For adults ≥ 65 years, there were sharp increases across all substances with larger increases in opioids (APC of 10.66%) compared to adults 55–64 (APC of 6.49%). For both age groups and among the four substances, alcohol-related hospitalizations were the leading cause of discharge to a SNF.ConclusionsWe found an increase in hospital discharges to SNFs for patients age 55 and older admitted with alcohol or drug-related diagnoses. Post-acute and long-term care settings should prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into their care settings.

Families' perspectives on monitoring infants' health and development after discharge from NICUs.

Based on a survey of families of very preterm infants, Seppanen et al report that: 1) parents rated post-discharge (post-NICU) care as poor or fair for 14.2% of children; 2) parents of one-third of children with health or developmental disorders rated their child’s post-hospital care as poor or fair, as compared to 12–13% of parents of typically developing and healthy children; and 3) parents’ suggestions for ways to improve post-hospital care focused primarily on better communication between the health care team and parents and better coordination of the child’s care. These findings point to a large opportunity for improving post-NICU services for infants born very preterm, especially for children with health or developmental disorders. In addition to gathering more information about families’ perspectives, vigorous quality improvement methods should be applied to improve the effectiveness of post-NICU clinics and the health and development outcomes of the infants and families served by these clinics.

Health care costs of injury in the older population: a prospective multicentre cohort study in the Netherlands

BackgroundWith the ageing population, the number of older trauma patients has increased. The aim of this study was to assess non-surgical health care costs of older trauma patients and to identify which characteristics of older trauma patients were associated with high health care costs.MethodsTrauma patients aged ≥65 years who were admitted to a hospital in Noord-Brabant, the Netherlands, were included in the Brabant Injury Outcome Surveillance (BIOS) study. Non-surgical in-hospital and up to 24- months post-hospital health care use were obtained from hospital registration data and collected with the iMTA Medical Consumption Questionnaire which patients completed 1 week and 1, 3, 6, 12 and 24 months after injury. Log-linked gamma generalized linear models were used to identify cost-driving factors.ResultsA total of 1910 patients were included in the study. Mean total health care costs per patient were €12,190 ranging from €8390 for 65–69 year-olds to €15,550 for those older than 90 years. Main cost drivers were the post-hospital costs due to home care and stay at an institution. Falls (72%) and traffic injury (15%) contributed most to the total health care costs, although costs of cause of trauma varied with age and sex. In-hospital costs were especially high in patients with high injury severity, frailty and comorbidities. Age, female sex, injury severity, frailty, having comorbidities and having a hip fracture were independently associated with higher post-hospital health care costs.ConclusionsIn-hospital health care costs were chiefly associated with high injury severity. Several patient and injury characteristics including age, high injury severity, frailty and comorbidity were associated with post-hospital health care costs. Both fall-related injuries and traffic-related injuries are important areas for prevention of injury in the older population.

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020).

BackgroundCoronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research.MethodsAn International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion.ResultsThe Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder.ConclusionsThe Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.

Virological failure, HIV-1 drug resistance, and early mortality in adults admitted to hospital in Malawi: an observational cohort study

SummaryBackgroundAntiretroviral therapy (ART) scale-up in sub-Saharan Africa combined with weak routine virological monitoring has driven increasing HIV drug resistance. We investigated ART failure, drug resistance, and early mortality among patients with HIV admitted to hospital in Malawi.MethodsThis observational cohort study was nested within the rapid urine-based screening for tuberculosis to reduce AIDS-related mortality in hospitalised patients in Africa (STAMP) trial, which recruited unselected (ie, irrespective of clinical presentation) adult (aged ≥18 years) patients with HIV-1 at admission to medical wards. Patients were included in our observational cohort study if they were enrolled at the Malawi site (Zomba Central Hospital) and were taking ART for at least 6 months at admission. Patients who met inclusion criteria had frozen plasma samples tested for HIV-1 viral load. Those with HIV-1 RNA of at least 1000 copies per mL had drug resistance testing by ultra-deep sequencing, with drug resistance defined as intermediate or high-level resistance using the Stanford HIVDR program. Mortality risk was calculated 56 days from enrolment. Patients were censored at death, at 56 days, or at last contact if lost to follow-up. The modelling strategy addressed the causal association between HIV multidrug resistance and mortality, excluding factors on the causal pathway (most notably, CD4 cell count, clinical signs of advanced HIV, and poor functional and nutritional status).FindingsOf 1316 patients with HIV enrolled in the STAMP trial at the Malawi site between Oct 26, 2015, and Sept 19, 2017, 786 had taken ART for at least 6 months. 252 (32%) of 786 patients had virological failure (viral load ≥1000 copies per mL). Mean age was 41·5 years (SD 11·4) and 528 (67%) of 786 were women. Of 237 patients with HIV drug resistance results available, 195 (82%) had resistance to lamivudine, 128 (54%) to tenofovir, and 219 (92%) to efavirenz. Resistance to at least two drugs was common (196, 83%), and this was associated with increased mortality (adjusted hazard ratio 1·7, 95% CI 1·2–2·4; p=0·0042).InterpretationInterventions are urgently needed and should target ART clinic, hospital, and post-hospital care, including differentiated care focusing on patients with advanced HIV, rapid viral load testing, and routine access to drug resistance testing. Prompt diagnosis and switching to alternative ART could reduce early mortality among inpatients with HIV.FundingJoint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, and Wellcome Trust.

Prehospital and Posthospital Fall Injuries in Older US Adults

To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings. To estimate the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization. This cohort study is a longitudinal analysis of 12-month periods that include an anchor hospital stay using national data from 2006 to 2014. Participants included older (aged ≥65 years) Medicare fee-for-service beneficiaries from the Health and Retirement Study. Weekly fall injury rates were computed for 4 periods compared with the anchor hospitalization: at baseline (1-6 months before hospitalization), just before (<1 month before hospitalization), just after (<1 month after hospitalization), and at follow-up (1-6 months after hospitalization). Piecewise logistic regression models estimated weekly marginal risk of fall injury within each period, adjusting for sociodemographic and health characteristics. Fall injury risks for high-risk beneficiaries with a fall injury during the anchor hospitalization were also estimated. Data analysis was performed from November 2019 to April 2020. Fall injuries. In total, 10 106 anchor hospitalizations for 4101 beneficiaries (mean [SD] age, 77.1 [7.6] years; 5912 hospitalizations among women [58.5%]) were identified. The overall fall injury risk was 0.77%. In adjusted models, marginal increases in weekly fall injury risk just before hospitalization (0.27 percentage points [95% CI, 0.22 to 0.33 percentage points], or 30.0%; P < .001) were 4 times greater than decreases just after hospitalization (-0.18 percentage points [95% CI, -0.23 to -0.13 percentage points], or -9.2%; P < .001)]. A greater risk differential before and after hospitalization was observed for patients with an inpatient fall injury (1.89 percentage points [95% CI, 1.37 to 2.40], or 309.8%; P < .001; vs -0.39 percentage points [95% CI, -0.73 to -0.04], or -11.6%; P = .03). An episode-based assessment of fall injury illustrates substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods include sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed. These could include bundled payments for fall injury episodes that incentivize coordination across settings.

Development and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makers

BackgroundSurrogate decision makers of stroke patients are often unprepared to make critical decisions on life-sustaining treatments. We describe the development process and key features for the Understanding Stroke web-based decision support tool.MethodsWe used multiple strategies to develop a patient-centered, tailored decision aid. We began by forming a Patient and Family Advisory Council to provide continuous input to our multidisciplinary team on the development of the tool. Additionally, focus groups consisting of nurses, therapists, social workers, physicians, stroke survivors, and family members reviewed key elements of the tool, including prognostic information, graphical displays, and values clarification exercise. To design the values clarification exercise, we asked focus groups to provide feedback on a list of important activities of daily living. An ordinal prognostic model was developed for ischemic stroke and intracerebral hemorrhage using data taken from the Virtual International Stroke Trials Archive Plus, and incorporated into the tool.ResultsFocus group participants recommended making numeric prognostic information optional due to possible emotional distress. Pie charts were generally favored by participants for graphical presentation of prognostic information, though a horizontal stacked bar chart was also added due to its prevalence in stroke literature. Plain language descriptions of the modified Rankin Scale were created to accompany the prognostic information. A values clarification exercise was developed consisting of a list of 13 situations that may make an individual consider comfort measures only. The final version of the web based tool (which can be viewed on tablets) included the following sections: general introduction to stroke, outcomes (prognostic information and recovery), in-hospital and life-sustaining treatments, decision making and values clarification, post-hospital care, tips for talking to the health care team, and a summary report. Preliminary usability testing received generally favorable feedback.ConclusionWe developed Understanding Stroke, a tailored decision support tool for surrogate decision makers of stroke patients. The tool was well received and will be formally pilot tested in a group of stroke surrogate decision makers.Trial registrationClinicalTrials.gov (NCT03427645).

The use of hospital consumer assessment of healthcare services and the Press Ganey medical practice surveys in guiding surgical patient care practices.

Background: Patient satisfaction questionaries have become popular in the past decade after the institution of the Patient Care and Affordable Care Act of 2010. This study evaluated whether the Hospital Consumer Assessment of Healthcare Services (H-CAHPS) and Press Ganey scores improved after institutional changes to the rounding system.Methods: In the summer of 2017, utilizing H-CAHPS and Press Ganey scores, we asked whether switching from mid-level rounding providers to resident physicians improved patient care. Pre- and post-intervention groups, each lasting four quarters, were divided into care provided by mid-level personnel versus residents. For these periods, H-CAHPS respondent data were compared by a Chi-squared test (P < 0.05), while Press Ganey responses were analyzed with an independent samples t-test (P < 0.05).Results: Significant improvement was noted in patients answering “Definitely yes” in recommending our institution in both H-CAHPS and Press Ganey satisfaction surveys. Significant improvement regarding the speed of discharge, instructions for post-hospital care, and the overall rating of care given was observed in the Press Ganey responses alone.Conclusion: Significant improvement in satisfaction was noted in the Press Ganey responses regarding the discharge process and speed of discharge. The quality of this last encounter likely contributed to+ the significant improvement observed in both the H-CAPHS and Press Ganey Scores for an overall hospital stay and the percentage of those definitely recommending our institution.

Evaluation of the Determinant Factors and Clinical Implications of Self-Care Agency Among Patients with Acute Myocardial Infarction.

In patients with acute myocardial infarction treated with percutaneous coronary intervention (PCI), effective post-hospital care, partially determined by self-care agency, is critical for long-term prognosis. However, the relationship between agency and sociodemographic characteristics requires elucidation. One hundred and six outpatients participated in our study. Self-care agency was assessed with the Self-care Agency Questionnaire (SCAQ). We evaluated its correlation with patients' sociodemographic characteristics and morale on the Ikigai-9 Questionnaire. Mean SCAQ scores were higher in those who were younger, male, living with someone, and more educated compared to their counterparts. Furthermore, SCAQ scores were correlated with Ikigai-9 scores. Multivariate logistic regression analyses indicated that social participation, employment status, and morale were independent predictors of high SCAQ scores. A comprehensive approach utilizing medical professionals, families, and the local community is needed to promote self-care agency in patients receiving primary PCI.

The Impact of Anticoagulation on Trauma Outcomes : An National Trauma Data Bank Study.

Increased prevalence of patients on anticoagulants and the advent of new therapies raise concern over how these patients fare if they sustain a traumatic injury. We investigated the role of prehospitalization anticoagulation therapy in trauma-related mortality and postacute disposition. A retrospective analysis was performed on patients who sustained traumatic injury identified in the 2017 National Trauma Data Bank (NTDB). Patients with and without anticoagulation therapy were analyzed to identify differences in demographics, injury type, Injury Severity Score (ISS), and trauma outcomes including hospital length of stay, ER, final hospital disposition, and mortality. Logistic regression was used to correlate anticoagulation to mortality and facility discharge. Of the 1 000 596 patients included, 73 602 (7%) patients were on anticoagulants at the time of their trauma. Increased age was the strongest predictor for anticoagulation therapy (odds ratio 5.54, 95% CI 5.44-5.63), but being female and white were also independent predictors of anticoagulation (P < .001). Patients on anticoagulants had a significantly longer length of stay (5.11 days; 95% CI 5.06-5.15) than those who were not (4.37 days, 95% CI 4.36-4.39), were 2.20 times more likely to die (95% CI 2.12-2.28, P < .001), and were 2.77 times more likely to be discharged to a facility (95% CI 2.73-2.81, P < .001). Anticoagulation remained a significant predictor of worse trauma outcomes even when accounting for age and ISS in multivariate analysis. Anticoagulation preceding trauma-related admission is associated with higher mortality and an increased likelihood of the need for a posthospital care facility.

Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

Post-hospital medical respite care for homeless people in Denmark: a randomized controlled trial and cost-utility analysis

Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care. A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire. After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains. This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach. ClinicalTrials.gov Identifier: NCT02649595.

Assessment of long-term psychosocial outcomes in anti-NMDA receptor encephalitis

PurposeThe purpose of this study was to assess long-term psychosocial outcomes of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (anti-NMDARE). MethodsAdolescents and adults with self-reported anti-NMDARE were invited to complete an online survey distributed by relevant patient organizations. Demographic and clinical information was collected, including the diagnoses initially given for anti-NMDARE symptoms and posthospital care received. Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Impact Illness – Negative short form (Negative PSII) was administered to assess psychosocial outcome of anti-NMDARE. Associations between clinical factors and psychosocial outcomes were evaluated. ResultsSixty-one individuals with anti-NMDARE age 15 years and above participated. Mean age was 33.7 years (standard deviation [SD]: 12.8), and participants were predominantly female (90.2%, n = 55). Mean T-score on PROMIS Negative PSII was 60.7, >1 SD higher (worse psychosocial function) than that of the provided normalized sample enriched for chronic illness (50, SD: 10). Initial misdiagnosis of anti-NMDARE symptoms was associated with decreased odds (odds ratio [OR]: 0.11, p < 0.05), and follow-up with a psychiatrist after hospitalization with increased odds (OR: 8.46, p < 0.05), of return to work/school after illness. Younger age of symptom onset and presence of ongoing neuropsychiatric issues were predictive of worse Negative PSII scores (p < 0.05). ConclusionIndividuals with anti-NMDARE demonstrate poor psychosocial outcomes, yet there are no current standards for long-term assessment or management of such symptoms in this population. These findings highlight the need for use of more comprehensive outcome measures that include assessment of psychosocial function and the importance of developing interventions that address this domain for individuals with anti-NMDARE.

The Advanced Practice Nurse Will See You Now: Impact of a Transitional Care Clinic on Hospital Readmissions in Stroke Survivors.

There is a paucity of evidence-based, posthospital stroke care in the United States proven to reduce preventable hospital readmissions. Follow-up with a provider after hospitalization for stroke or transient ischemic attack had low compliance rates. This may contribute to preventable readmissions. A retrospective, descriptive chart review to determine whether an advanced practice registered nurse (APRN)-led transitional care clinic for stroke survivors impacted 30- and 90-day hospital readmissions. Readmissions between clinic patients and nonclinic patients were compared. The site implemented an APRN-led transitional care stroke clinic to improve patient transitions from hospital to home. The 30-day readmission proportion was significantly higher in nonclinic patients (n = 335) than in clinic patients (n = 68) (13.4% vs 1.5%, respectively; P = .003). The 90-day readmission proportion was numerically higher in nonclinic patients (12.8% vs 4.4%, respectively; P = .058). The results suggest the APRN-led clinic may impact 30-day hospital readmissions in stroke/transient ischemic attack survivors.

Follow-Up Care After Behavioral Health-Related Hospitalization for Children and Adolescents.

Although the coordination of follow-up behavioral health-related care between hospitals and outpatient behavioral health care settings is important, studies on this topic are few. Claims were selected from Truven Health Analytics' Marketscan databases during 2014 for youth aged 2-18years who had an inpatient stay with a behavioral health diagnosis. Analyses identified whether youth received a behavioral health follow-up visit within 30days following a hospitalization. The percentage of children who received post-hospitalization follow-up care was 59.1% (Medicaid) and 59.4% (private insurance). While children less than 15years old (Medicaid) had increased odds of follow-up care compared with youth aged 15-18years, children 2-9years old with commercial insurance had decreased odds of follow-up care. Variations in follow-up care by patient characteristics provide an opportunity to target efforts to increase coordinated care to those who are least likely to receive it.